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Life sciences · Journal article
Quality of Life Research · October 22, 2026
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Prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) and its progressive form, metabolic dysfunction-associated steatohepatitis (MASH), is increasing globally. Assessment of health-related quality of life (HRQoL), alongside non-invasive tests (NITs), may support identification of patients requiring closer clinical management. This multinational real-world randomised controlled trial evaluated associations between HRQoL (using the EQ-5D) and multiparametric MRI (mpMRI) markers of liver disease. RADIcAL-1 included 802 patients (453 male) with suspected MASLD/MASH from Germany, Netherlands, Portugal and UK. Participants completed the EQ-5D-5 L at baseline, 2, 6 and 12-months. EQ-VAS was derived to assess overall health. Between-group comparisons (imaging vs. standard-of-care) were assessed using t-tests, and multivariable logistic regression adjusted for age, obesity, diabetes and hyperlipidaemia. MASH was defined as corrected T1 (cT1) ≥800ms and liver fat as proton density fat fraction (PDFF) ≥ 10%. High-risk MASH was cT1 ≥ 875ms. Within the imaging arm, patients with MASH reported lower HRQoL across all EQ-5D dimensions and EQ-VAS compared with MASLD. Baseline utilities ranged from 0.81 (Coimbra) to 0.90 (Ulm) and this range decreased at month 12 from 0.82 (Coimbra and UK) to 0.90 (Ulm). These findings remained after adjustment for comorbidities. Patients with high-risk MASH reported up to 12% more complaints in all EQ-5D dimensions compared to all others. Increasing cT1 was associated with 29% higher odds of reporting anxiety/depression. An 80ms increase in cT1 was associated with 0.023-point decrease in EQ-5D utility (p = 0.039). Due to COVID-19, 12-month response rates varied across sites (22–81%). mpMRI-defined MASH is associated with worse HRQoL independent of key metabolic comorbidities. These findings support the use of imaging biomarkers for disease stratification and for identifying patients with greater clinical burden, with potential implications for management and monitoring strategies. Currently, assumed utility decrements may be used in economic modelling and decision making. Therefore, there is a need to establish relationships between non-invasive test outputs and health related quality of life (HRQoL) in liver disease. This study presents the HRQoL from a large, randomised control trial that took place in several European countries. Across all jurisdictions, self-care and usual activities had the lowest HRQoL scoring, whilst pain/discomfort had the highest. There were no differences between reported HRQoL in the study arms, however within the imaging arm, those with metabolic dysfunction-associated steatohepatitis (MASH) and therefore higher corrected T1 values, reported a lower HRQoL compared to those with metabolic dysfunction-associated steatotic liver disease (MASLD). These findings provide important evidence linking non-invasive tests to patient reported outcomes that may be incorporated into economic evaluations and clinical risk stratification pathways in the MASLD/MASH disease space.